| Literature DB >> 34403791 |
Betül Oran1, Kwang Woo Ahn2, Caitrin Fretham3, Amer Beitinjaneh4, Asad Bashey4, Attaphol Pawarode5, Baldeep Wirk6, Bart L Scott7, Bipin N Savani8, Christopher Bredeson9, Daniel Weisdorf10, David I Marks11, David Rizzieri12, Edward Copelan13, Gerhard C Hildebrandt14, Gregory A Hale15, Hemant S Murthy16, Hillard M Lazarus17, Jan Cerny18, Jane L Liesveld19, Jean A Yared20, Jean Yves-Cahn21, Jeffrey Szer22, Leo F Verdonck23, Mahmoud Aljurf24, Marjolein van der Poel25, Mark Litzow26, Matt Kalaycio27, Michael R Grunwald13, Miguel Angel Diaz28, Mitchell Sabloff29, Mohamed A Kharfan-Dabaja16, Navneet S Majhail30, Nosha Farhadfar31, Ran Reshef32, Richard F Olsson33, Robert Peter Gale34, Ryotaro Nakamura35, Sachiko Seo36, Saurabh Chhabra37, Shahrukh Hashmi38, Shatha Farhan39, Siddhartha Ganguly40, Sunita Nathan41, Taiga Nishihori42, Tania Jain43, Vaibhav Agrawal44, Ulrike Bacher45, Uday Popat46, Wael Saber47.
Abstract
Reduced-intensity conditioning (RIC) regimens developed to extend the use of allogeneic hematopoietic stem cell transplantation (HSCT) to older patients have resulted in encouraging outcomes. We aimed to compare the 2 most commonly used RIC regimens, i.v. fludarabine with busulfan (FluBu) and fludarabine with melphalan (FluMel), in patients with myelodysplastic syndrome (MDS). Through the Center for International Blood and Marrow Transplant Research (CIBMTR), we identified 1045 MDS patients age ≥60 years who underwent first HSCT with a matched related or matched (8/8) unrelated donor using an RIC regimen. The CIBMTR's definition of RIC was used: a regimen that incorporated an i.v. busulfan total dose ≤7.2 mg/kg or a low-dose melphalan total dose ≤150 mg/m2. The 2 groups, recipients of FluBu (n = 697) and recipients of FluMel (n = 448), were comparable in terms of disease- and transplantation-related characteristics except for the more frequent use of antithymocyte globulin or alemtuzumab in the FluBu group (39% versus 31%). The median age was 67 years in both groups. FluMel was associated with a reduced relapse incidence (RI) compared with FluBu, with a 1-year adjusted incidence of 26% versus 44% (P ≤ .0001). Transplantation-related mortality (TRM) was higher in the FluMel group (26% versus 16%; P ≤ .0001). Because the magnitude of improvement with FluMel in RI was greater than the improvement in TRM with FluBu, disease-free survival (DFS) was better at 1 year and beyond with FluMel compared with FluBu (48% versus 40% at 1 year [P = .02] and 35% versus 27% at 3 years [P = .01]). Overall survival was comparable in the 2 groups at 1 year (63% versus 61%; P = .4) but was significantly improved with FluMel compared with FluBu at 3 years (46% versus 39%; P = .03). Our results suggest that FluMel is associated with superior DFS compared with FluBu owing to reduced RI in older patients with MDS patients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.Entities:
Keywords: MDS; Melphalan; Relapse; Survival; Transplantation
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Year: 2021 PMID： 34403791 PMCID： PMC9562611 DOI： 10.1016/j.jtct.2021.08.007
Source DB: PubMed Journal: Transplant Cell Ther ISSN： 2666-6367